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We sit down with Muhamad Aly Rifai, a practicing internist and psychiatrist, to explore the complexities of health care fraud investigations and the profound impact these cases have on physicians’ lives and careers. Muhamad shares his firsthand experience of enduring a seven-year federal investigation that ultimately resulted in a “not guilty” verdict, highlighting the flawed legal system that targets dedicated health care professionals. We delve into the systemic issues within the justice system, the role of jury trials, and the urgent need for reforms to protect physicians from overzealous prosecutions.
Muhamad Aly Rifai is a practicing internist and psychiatrist in the Greater Lehigh Valley, Pennsylvania. He is the CEO, chief psychiatrist and internist of Blue Mountain Psychiatry.
He discussed the KevinMD article, “The continued unjust prosecution of physicians.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Muhamad Aly Rifai. He’s an internal medicine physician and psychiatrist. Today’s KevinMD article is “The Continued Unjust Prosecution of Physicians.” Muhamad Ali, welcome to the show.
Muhamad Aly Rifai: Thank you very much for having me today, talking to your audience.
Kevin Pho: All right. So let’s start by briefly sharing your story and journey.
Muhamad Aly Rifai: So, by training, I’m an internist and a psychiatrist. And I’ve done a lot of pioneering work on telehealth. I started doing telepsychiatry in 2006 and also started doing telepsychiatry in nursing homes in rural Pennsylvania. That, for some reason, led me to become under the watchful eye of the United States Department of Justice and the Department of Health and Human Services. So, that led to investigations, and a lot of these things were related to errors that were done by the Centers for Medicare Services in terms of implementing telehealth services and telepsychiatry. This was prior to the COVID time. So, not a lot of people were doing telehealth and telepsychiatry, and ultimately, after COVID, in 2022, they decided to bring back this old investigation from 2017.
I was indicted for health care fraud for services that we provided in 2017. I believed in the work I’d done. I believed in my services. I believed that everything I did was right. The Department of Justice’s opinion was actually based on a lawyer’s opinion, not on consultations with any psychiatrist, coders, or anyone experienced in the field of telehealth, telepsychiatry, or psychiatry in general.
I decided to go to trial. We went to trial. I had two witnesses. I had a coder, and I had a practicing psychiatrist from the community. The jury listened to the evidence we provided, and they felt the services we provided were legitimate. They found me not guilty. I have a long story to tell, and there are a lot of things that individuals out there practicing, seeing Medicare patients, seeing private insurance patients, can benefit from—especially learning from my experience and what I went through.
Kevin Pho: All right. We’re going to talk more about that story. You articulated it in your KevinMD article, “The Continued Unjust Prosecution of Physicians.” So, Muhamad Ali, tell me about the first time you were contacted by the government and first notified that there was potential fraud.
Muhamad Aly Rifai: The first time was actually in June of 2019. It was a very difficult day. I was practicing. It was a normal day. And then, all of a sudden, 10 to 15 agents from the Office of the Inspector General for the Department of Health and Human Services burst into my office with a search warrant, wanting patient records.
It turned out they had gathered a lot of evidence, which they did not use, did not review, and did not look at. Fortunately for me, we used that, because they basically did not look at the facts. They had already made up their minds that I was their person: a Middle Eastern physician, a psychiatrist, a minority, doing innovative work. At that time, I was also the president of the local psychiatric society in my area. I was the president of the Lehigh Valley Psychiatric Society. So, I represented the field of psychiatry, and for the government to say, “Well, the president of this psychiatric society is committing fraud,” was a big blow to my professional reputation.
That’s why I felt I needed to go to trial to defend not just myself but also the integrity of the profession of psychiatry, because, in part, the government said, “We brought this case to teach psychiatrists not to steal from Medicare.”
Kevin Pho: Before going into that experience, just so we’re clear, what did these federal agents or the government accuse you of doing?
Muhamad Aly Rifai: The gist of the accusation was that we billed for services that were not provided. Our contention was that we did provide these services based on the coding and documentation we had. The opinion presented was actually the lawyer’s opinion. It wasn’t a coder; it wasn’t an expert coder; it wasn’t a psychiatrist. The lawyer said, “I don’t think you provided these services,” and they ran with the case. What we did was bring in an expert psychiatrist and an expert coder. They said, “Based on this documentation, these services were provided.” It was psychotherapy. It was talking to patients. The government accused us of not talking to patients or not documenting that we talked to patients. It was all documented. The government misunderstood the coding rules and regulations.
Kevin Pho: Where did you turn to next? After the initial shock dissipated and you decided on your next steps, where did you turn for resources?
Muhamad Aly Rifai: I turned to find effective legal representation, and I was very fortunate to find an attorney, Mr. Paul Hetznecker, whose father is a psychiatrist and whose brother is a psychiatrist. He knew the field of psychiatry very well and very quickly understood what I was going through. We tried to dissuade the government from filing a criminal indictment, but we were not successful. They were just determined that what we did was fraudulent, what my practice did was fraudulent, and they proceeded with an indictment. We decided to go to trial.
Kevin Pho: What other options did you have other than going to trial? What were your other possibilities?
Muhamad Aly Rifai: The majority of people in the United States—by the majority, I mean like 97 percent—who are indicted end up pleading guilty to some charge. Very few people go to trial. Only about 2 percent go to trial, and out of those 2 percent, only about 30 or 40 percent are found not guilty. So, out of 100 percent that get indicted, only 0.4 percent are found not guilty.
Kevin Pho: If a physician pleads guilty to a federal charge, what are the consequences of that decision?
Muhamad Aly Rifai: They lose their license, they lose their freedom, they’re incarcerated, and they most likely will not be able to participate in Medicare and Medicaid programs. They will be excluded for a period of time, depending on the severity of their actions. Basically, their career in terms of providing medical services is almost over, in terms of the ramifications of what happens. This happens to the majority of people who are indicted. They end up pleading because they do not want to face the federal government. I was under the threat of being sentenced to up to 40 years.
Kevin Pho: Forty years? Wow.
Muhamad Aly Rifai: Yes. And the value of the charges the government claimed were fraudulent was $180,000, and they extrapolated that based on services we provided over five years to $1.2 million.
Kevin Pho: Given the choice of pleading guilty and potentially facing 40 years in prison, why don’t more physicians just go to trial, given the alternative set of circumstances? What are the risks of going to trial?
Muhamad Aly Rifai: It is very scary. Physicians are scared. Their lawyers scare them that the likelihood of prevailing at trial is very low. Sometimes, physicians are not very knowledgeable about the circumstances of what they’re being accused of. The government is always very vague and doesn’t give you the evidence against you until the last moment. They gave me some evidence against me on the eve of the trial. Two days into the trial, they gave us additional evidence. So, basically, if you’re not knowledgeable about the evidence against you, you don’t go to trial. Yet, people plea. But juries are very understanding. They’re very attentive, and they are probably going to be very sympathetic to physicians just because of the complexity of the health care system. It’s never black and white. It’s never “this is definitely wrong” or “this is definitely right.” So, there’s always the opportunity to present the case at trial.
I think physicians, if they’re accused, should go to trial, because they will have an opportunity to prevail. I also have a lot of experience with the legal system, being a psychiatrist. I’ve testified in court before. I’ve been in courts as an expert witness. I have experience being in court, so it wasn’t a very scary experience for me. I said, “I’m going to defend myself and defend the integrity of the field of psychiatry.”
Kevin Pho: Let’s talk about the trial itself. What was that like for you? How long did it last?
Muhamad Aly Rifai: The trial lasted for six days. It was a very surreal experience. It wasn’t your usual trial in a big city where you have a full courtroom, people listening, and sounds. It was in a rural area, so there were probably one or two people in the courtroom. It was very dystopian. It was the judge, his staff, my lawyer and his assistant, myself, two agents from the government, two lawyers from the government, and the jury. That’s it. It was almost an empty courtroom. Our witnesses presented. My lawyer cross-examined the witnesses. I think the pivotal moment in my trial was when my lawyer was cross-examining the government’s main expert coder, and once she realized the amount of errors she had committed in her report, she started crying on the stand. And I think that was the moment where the jury just turned and said, “This is it. This doctor is innocent.” If the government’s main expert witness is crying on the stand, this case is over.
Kevin Pho: Now that you’ve had time to reflect on the case, did you feel that the government acted in bad faith and, as you alluded to earlier, targeted you because you represented psychiatry and the fact that you were a minority?
Muhamad Aly Rifai: It’s hard to say. I think there were multiple things going on at that time. There was a new U.S. attorney in the Eastern District of Pennsylvania where I practice. They were not sure whether they were going to file an indictment or agree to settle the case civilly. But I do think there could have been other ways to handle the case that didn’t involve a criminal trial. Probably, in seeing the outcome of this case, the government may learn to handle these situations differently in the future. Maybe it was a lesson to the government as well as to physicians that they need to fight for their rights and not just cave in and go to jail.
Basically, the criminal justice system in the United States is such that once someone is indicted, they almost always plea. Nine out of 10 will plea, and they end up having a criminal charge and going to jail.
Kevin Pho: In your article, you wrote that from beginning to end, this was a seven-year process or something like that?
Muhamad Aly Rifai: Yes, it started in 2017. The investigation began unbeknownst to me. There were things going on, with investigations and attempts to obtain information, and it ended in May 2024.
Kevin Pho: And after you got that jury verdict, is it really over? Are there any appeals, repercussions, or ramifications, or was it truly over?
Muhamad Aly Rifai: It’s never over. It’s never truly over. There are no appeals. The jury verdict is final, so the criminal case is over. However, they’re still trying to levy some sanctions against me. Part of the case involved sending in an undercover person, which wasn’t successful, and they’re trying to pursue that. So, we’re still fighting legally, and it never ends. Hopefully, it will end sometime next year, but the government doesn’t give up and will continue to pursue someone.
My patients stuck with me. I continued to see patients throughout the case. The government wasn’t very happy about that, but I kept seeing patients. Medicare reinstated me into their good graces, and they want me to continue seeing patients because I’m in a rural area, and there are no other psychiatrists. I’m the only psychiatrist in my area. There’s nobody else to see these patients, and so I hope that things will end and the legal trouble will conclude.
Kevin Pho: How did this case affect you personally and emotionally?
Muhamad Aly Rifai: It’s like being run over by a train. I think that’s the best way to describe it. I’m a psychiatrist, and people ask me if I have post-traumatic stress disorder. Well, maybe. That’s definitely within the realm of what happens to a person when they go through an experience like this. I was resigned to the idea that I might go to jail. Up to the point where my lawyer said, “If you’re convicted, you need to decide which jail you’re going to.” So, I went and visited the jail. I wanted to know exactly where my destination would be if I was convicted. Because when you go to trial, the outcomes are unknown, and you could be convicted. I went and visited the federal center in Otisville, New York. That’s where I would have gone had I been found guilty. People need to understand the potential outcomes of going to trial.
Kevin Pho: We’re talking to Muhamad Aly Rifai. He’s a practicing internal medicine physician and psychiatrist, and today’s KevinMD article is “The Continued Unjust Prosecution of Physicians.”
Muhamad Aly, let’s end with some advice you can give to physicians who may be in similar situations and your take-home messages.
Muhamad Aly Rifai: Advice? I think legal advice is essential. Find a good lawyer experienced in health care issues as well as criminal matters. That’s very important. Find experts who will help in your case. The government often doesn’t have the right experts helping them. I mentioned multiple other cases in the article, including the Dr. Bothra case in Detroit, where they accused Dr. Bothra and his colleagues of stealing $450 million. They went to trial and were found not guilty. How can you accuse someone of stealing $450 million, and then it all disappears at trial? It was either a big smokescreen, or doctors really need to stand up for themselves.
Take-home messages: I think for physicians, it’s important to know the coding regulations in your field. You must understand the coding regulations because nobody else is going to help you with those. Make sure you’re following those regulations.
Kevin Pho: Muhamad Aly, thank you so much for sharing your story, perspective, and insight, and thanks again for coming on the show.
Muhamad Aly Rifai: Thank you.
